How Perimenopause Affects Sleep (And What You Can Do About It)

By Nutritional Weight and Wellness Staff
August 4, 2025

If you’re a perimenopausal woman experiencing poor sleep, you’re not alone. Sleep issues during perimenopause are some of the most common complaints we hear—especially trouble falling asleep, night sweats, waking during the night, and disrupted sleep in general. The menopausal transition brings hormonal changes that impact sleep quality for many middle-aged women, but there’s a lot you can do to improve sleep naturally.

"In reality, many women today start perimenopause in their late thirties and most women go into menopause in their fifties, but there can be a lot of variability at what age that you do go into perimenopause or menopause." Britni Vincent RD, LD

Why Sleep Issues Happen in Perimenopause

“When our clients start perimenopause, one of the first symptoms many of our clients have is having sleep problems.”
— Melanie Beasley RD, LD

1. Hormonal Changes & Menopausal Symptoms

“I would say sleep is one of the most common issues that comes up during a nutrition counseling session. But especially in those perimenopause or menopausal or postmenopausal years”
— Leah Kleinschrodt MD, RD, LD

As your body moves into perimenopause, it’s normal for sleep to get a little bumpy. The main reason? Those shifting hormones—especially estrogen and progesterone—are doing their own rollercoaster ride.

Here’s what’s happening: As you get closer to menopause, your ovaries start producing less estrogen (specifically the form estradiol) and progesterone. But they don’t go down evenly. Progesterone, which helps calm the brain and support restful sleep, often drops more sharply. Estrogen levels go down, too, but your body can still make a bit of estrogen from places like your fat cells and adrenal glands. Because of this, some individuals end up with more estrogen compared to progesterone—what’s called “estrogen dominance.”

That hormonal imbalance is a big part of why sleep goes sideways during perimenopause. With less progesterone, falling asleep and staying asleep can be a challenge. Fluctuating estrogen adds to the chaos by throwing off your usual sleep-wake cycle and often triggering night sweats or hot flashes. All of that can lead to more restlessness, irritability, and even more tossing and turning.

The good news? These changes are common, and there’s a lot you can do. Balancing hormones—starting with real-food nutrition and simple lifestyle tweaks—can make a big difference in how well you sleep and how you feel through this transition.

2. Night Sweats and Hot Flashes

Night Sweats & Hot Flashes: Why They Happen

"Oftentimes, women in menopause are experiencing these hormonal changes, which can cause these sleep issues. Sometimes night sweats, wake them up. You know, I have many times had women come in and tell me that they have to change their pajamas in the middle of the night. It sounds pretty miserable; not comfortable at all." Britni Vincent RD, LD

If you’re tossing off the covers at 2am or waking up feeling like you just ran a marathon in your sleep, you’re experiencing one of the most classic signs of perimenopause: night sweats and hot flashes. These aren’t just random, and you’re definitely not imagining it. As hormone levels— estrogen and progesterone—start to shift and drop, your body’s thermostat gets a little out of whack. That’s what leads to those sudden, overwhelming waves of heat.

Hot flashes can happen anytime, but when they strike at night, they’re called night sweats. It’s not just a gentle warming—it can feel like a surge of heat that starts in your chest or neck and spreads out, sometimes with sweating, a flushed face, a pounding heart, or even a bit of anxiety or irritability. When this happens in the middle of the night, it’s no wonder you have disrupted sleep.

Some women might just get a little warm now and then, while others deal with intense episodes for years. Remember, this is your body’s way of adjusting to new hormone patterns—nothing is broken, and you’re not alone in it.

3. Anxiety, Depression, & Mental Health

If you’ve noticed that your mood and your sleep both seem to be all over the place lately, you’re definitely not alone. During perimenopause, it’s really common for women to find themselves feeling more anxious or down than usual—often right alongside new sleep struggles. Those hormonal shifts happening in the background can change the way your brain manages stress and emotions, making it harder to wind down at night or feel truly rested in the morning.

Here’s why: As estrogen starts to fluctuate and drop, it doesn’t just affect your cycle. Estrogen actually helps support some of your brain’s natural “feel good” messengers—like serotonin and norepinephrine—that help you feel balanced and calm. When estrogen dips, these brain chemicals aren’t as active, which can make it much easier to feel anxious, irritable, or low. On top of that, the decline in progesterone also affects serotonin and another neurotransmitter called GABA, which can cause more of those racing thoughts and mood imbalances.

When anxiety or a low mood ramps up, it can make falling asleep or staying asleep even tougher, which then leaves you feeling more exhausted—and often, even more anxious or down—the next day. It’s a frustrating cycle, and it all goes back to those hormonal shifts that are affecting both your mood and your body’s natural rhythms.

The more you understand how closely linked sleep and emotional health are during perimenopause, the more empowered you’ll be to notice patterns and start making changes that help you rest—and feel—better.

Tips to Improve Sleep Quality During Perimenopause

If sleep has become a nightly struggle, know that you’re not alone—and there are real, practical steps you can take to make things better.

Here are some tried-and-true strategies that can help support a more restful night, even through all the ups and downs of perimenopause:

• Stick to a Sleep Schedule:
  Try to go to bed and get up at the same time every day—even on weekends. This helps train your body’s internal clock and supports more consistent, restorative sleep.

• Keep Your Bedroom Cool and Comfortable:
  Temperature makes a big difference, especially if you’re dealing with night sweats or hot flashes. Use a fan, open a window, and try lightweight or moisture-wicking sheets and pajamas for a more restful night.

• Wind Down Before Bed:
  Give yourself at least 30 minutes to slow down before lights out. A warm shower or bath, gentle stretching, light reading, or soothing music can help signal to your brain and body that it’s time for rest. Try to avoid screens and intense TV before bed.

• Pay Attention to Food and Drink:
  Spicy foods, caffeine, alcohol, and sugar—especially later in the day—can all make hot flashes and restless nights more likely. And while it’s important not to go to bed hungry, steer clear of heavy meals right before bedtime.

• Balance Blood Sugar with Real Food:
  Eating balanced meals—plenty of protein, healthy fats, and veggies—throughout the day can keep your blood sugar steady. This not only helps with energy and mood, but can also make hot flashes, night sweats and sleep disruptions less likely.

• Add Magnesium-Rich Foods:
  Foods like leafy greens, pumpkin seeds, almonds, and cashews are natural sources of magnesium, a mineral that helps support relaxation and sleep.

• Move Your Body:
  Regular movement—like a walk or gentle exercise—can help support better sleep, but it’s best to finish any vigorous activity at least a few hours before bedtime.

• Take Care of Your Emotional Health:
  If you’re feeling anxious, stressed, or down, reach out for support. Talking to a nutritionist, counselor, or even a trusted friend can help lighten the mental load and make it easier to rest.

• Reach Out If Sleep Still Isn’t Coming:
  If you’ve tried these changes and are still struggling to get the sleep you need, don’t hesitate to check in with your healthcare provider. Persistent sleep problems deserve extra support.

Remember, improving sleep during perimenopause isn’t about perfection—it’s about small, sustainable shifts that add up over time. With patience, compassion, and a little trial and error, better nights are possible.

 

Additional Resources for Perimenopause Support

Guides & Articles:
Your Ultimate Guide to Menopause

This comprehensive article covers everything from what to expect during the menopausal transition to nutrition strategies, symptom management, and answers to your most common questions.

Menopause Diet: Can Nutrition Help Menopause?
Learn how real-food nutrition and meal timing can help balance hormones and reduce menopause symptoms—including sleep problems, hot flashes, and night sweats.

Differences Between Perimenopause & Menopause
Confused about what stage you’re in? This article clearly explains the differences between perimenopause, menopause, and post-menopause, so you know what to expect.

Supplements:

Our Top Recommended Menopause Supplements
Explore which nutrients and natural support—like magnesium, calcium, and GLA—can help you manage sleep issues, hot flashes, bone health, and more during perimenopause and menopause.

Podcasts:

Better Sleep During Perimenopause & Menopause
Listen to practical conversations with real women and nutritionists about getting quality sleep through the menopausal transition.

Relief for Menopause Symptoms
Hear from our team of nutritionists about the root causes of menopause symptoms and the steps you can take—starting with nutrition and lifestyle changes that really work.

Menopause Depression & Anxiety
A focused discussion on how hormone changes impact mood and what you can do to support your emotional wellbeing and sleep.

Courses & Classes:

Menopause Solutions Class
Our Menopause Solutions class dives deep into practical strategies and nutrition tools for symptom relief at every stage, including perimenopause. Six hours of on-demand video with real-food solutions, available at your own pace.